The challenges of routine COVID-19 testing in schools

At this point in the pandemic, we know that routine COVID-19 testing can be a key tactic for reducing transmission in communal settings. If you identify cases as soon as they occur through asymptomatic testing, you can quickly isolate those cases and quarantine their contacts—preventing the cases from turning into outbreaks. This strategy works everywhere from kindergarten classrooms to the NBA.

Despite the clear evidence that testing works, high case numbers in children in recent months, and millions of dollars in federal funding, many K-12 schools across the U.S. still aren’t doing any COVID-19 testing. Why not? I explain the hurdles in a story for Science News.

I found five major challenges:

  • Without clear guidance from public health officials, school leaders may struggle to make crucial decisions about testing logistics (such as which tests to use, how often to test, and who will do the testing).
  • One logistical decision can be particularly tough: what happens when a student or staff member tests positive?
  • Obtaining COVID-19 tests themselves can be a struggle in this era of endless supply chain shortages, if schools are not getting tests directly from state health agencies.
  • Schools must gain consent from their students’ families for COVID-19 testing, which can be logistically complicated and require a lot of communication.
  • Testing, like all COVID-19 safety measures, has become polarized—and can come with both political and personal baggage for families. 

You can read the full story for more details. But here, I wanted to share some notes from a section that was cut out of the article: one focusing on data. As longtime COVID-19 Data Dispatch readers know, I love to call out the lack of data on COVID-19 cases, tests, and other metrics in school settings.

Through reporting this article, I also learned that simply reporting testing numbers can be a major barrier for schools. In most cases, schools are required to submit all their test results to their state or local health departments; this type of health data reporting is not something that schools are cut out to do.

“Reporting test results to the appropriate public health authorities was something that school administrators, frankly, were not used to doing, and didn’t really know how to do,” Divya Vohra, an epidemiologist at the research organization Mathematica who studies testing programs, told me. Such reporting might require schools to set up an electronic records system like those used by hospitals, or it might require school nurses to manually enter data for every student.

Ideally, a school district would partner with “a vendor that comes in, reports the data for you to the state, and then also feeds that data into a dashboard” which school administrators can use in making decisions, said Leah Perkinson, testing program coordinator at the Rockefeller Foundation. But this type of partnership may be hard to come by, especially if schools are attempting to set up testing without support from their state health or education agencies.

As I’ve pointed out in the past, there is no national dataset of COVID-19 tests conducted in K-12 schools. New York is the only state reporting these data, along with some large districts such as Los Angeles Unified. Due to a lack of interest in K-12 testing prior to this fall, Perkinson says, “it wasn’t apparent that we need to build a centralized data reporting repository.” Now, many schools that might consider setting up a testing program are flying blind, without clear success stories to follow.

In addition, when the schools with testing programs in place do not actively monitor their own test results, they may miss out on valuable information, Alyssa Bilinski, a biostatistician at Brown’s School of Public Health, told me. Many districts rely on community COVID-19 metrics, such as the case rate in a county.

But “schools can vary a lot from the overall average, because kids can be really different from adults,” Bilinski said. “It’s a much more precise indicator if we have data for a particular school community.” (For more reading on this topic, I recommend Bilinski’s recent opinion piece in STAT News!)

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